Credit Application

Personal Information
First Name *
Last Name
Last Name *
Middle Initial
Social Insurance Number
Birth Date *
Apt
Street Address
P.O. Box
City *
Province *
Postal Code *
Home Telephone Number *
Marital Status
How long have you lived at the above address?
Years *
Months *
If Rent *
Landlord
Monthly Payment
If Own *
Mortgage Lender
Monthly Payment
Balance
Market Value
If you have not been at your current residence for more than 2 years please fill out the following
information about your previous residence.
Apt
Street Address
P.O. Box
City
Province
Postal Code
Email Address *
Is there a Co-Applicant? *
Yes
No
Employment and Income Information
Occupation *
Employer *
How long have you been there? *
Years *
Months *
Work Telephone Number
If you have not been at your current job for more than 2 years please fill out the following
information about your previous job.
Occupation
Employer
How long have you been there?
Years
Months
Work Telephone Number
Gross Monthly Income *
Additional Monthly Income
Source of Additional Income
Vehicle Information
Vehicle Interested In
Salesperson
Make
Model
Serial Number
Trade Information
If you have a current car loan please enter the following information about the loan.
Outstanding Balance
Lender
Additional Information
Additional Notes
Agreement
I agree that Riverside Dodge / Riverside Arctic Cat may use my information for credit purposes
Yes
No
Riverside Dodge
Riverside Melfort
Riverside Artctic Cat
RiverSide Hyndai
1-800-914-6422
1-866-371-2277
1-877-764-4218
1-888-763-4484